Provider Demographics
NPI:1275580854
Name:W SCOTT MOORE ET AL PTR
Entity Type:Organization
Organization Name:W SCOTT MOORE ET AL PTR
Other - Org Name:NEPHROLOGY ASSOCIATES, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:ROBBINS
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-245-6306
Mailing Address - Street 1:730 HIGHLAND OAKS DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-7108
Mailing Address - Country:US
Mailing Address - Phone:336-768-2425
Mailing Address - Fax:336-768-4915
Practice Address - Street 1:730 HIGHLAND OAKS DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-7108
Practice Address - Country:US
Practice Address - Phone:336-768-2425
Practice Address - Fax:336-768-4915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC61281207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902199Medicaid
NCBCBSOther02199
NC8979892Medicaid
NC8960539Medicaid
NC8928607Medicaid
NC891306MMedicaid
NC8902199Medicaid
NC89136NJMedicaid
NC8979892Medicaid
NC89136NHMedicaid
NC8928607Medicaid
NC230503Medicare PIN
NC8902199Medicaid
NC8960539Medicaid
NC1881679215Medicare PIN